title: Stroke severity and outcomes for octogenarians receiving statins.
abstract: Pre-exposure to 3-hydroxy-3-methylgutaryl-coenzyne A reductase inhibitors (statins) appears to improve outcomes in patients with acute ischemic stroke (AIS). Whether this extends to patients over 80 is not known. Patients ≥80 years of age with AIS were retrospectively reviewed from the stroke registry of a tertiary stroke center. Pre-admission statin use, demographics, vascular risk factors, and comorbid conditions were assessed. Primary outcomes were admission National Institutes of Health Stroke Scale (NIHSS) scores and in-hospital mortality/discharge to hospice, and secondary outcomes included subsequent intracerebral hemorrhage (ICH) and modified Barthel index (mBI) at 3 months. Multivariable logistic regression was used to evaluate the association between pre-admission statin use and outcomes among elderly patients. Among 804 patients ≥80, those taking statins prior to AIS admission were overall younger, were more likely to have hypertension, coronary artery disease, diabetes, hyperlipidemia, and were more likely to be on an antiplatelet, but less likely to receive treatment with IV tissue plasminogen activator (tPA). Patients on statin had lower stroke severity (NIHSS>16: 21.9% vs. 27.6%) and in-hospital mortality/discharge to hospice (22.8% vs. 27.6%), but neither was significant. There was no difference in ICH (1.2% vs. 1.9%), and patients on statins had a non-significant trend toward less disability on mBI (27.5% vs. 35.7%). Pre-admission statin use did not show a statistical difference in either outcome, but it did show a trend toward lower stroke severity and improved short-term outcomes. In addition, our study suggests that statins may be safe in elderly stroke patients and may not increase the risk of ICH.
authors.affiliation: Stroke Center at Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA. mphipps@calalum.org
authors.forename: Michael S
authors.initials: MS
authors.lastname: Phipps
authors.forename: Neer
authors.initials: N
authors.lastname: Zeevi
authors.forename: Ilene
authors.initials: I
authors.lastname: Staff
authors.forename: Gil
authors.initials: G
authors.lastname: Fortunato
authors.forename: George A
authors.initials: GA
authors.lastname: Kuchel
authors.forename: Louise D
authors.initials: LD
authors.lastname: McCullough
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D063868:Patient Outcome Assessment; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: 3-Hydroxy-3-methylgutaryl-coenzyne A reductase inhibitor; Elderly; Ischemic stroke; Statin; Stroke severity